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Heart rate response during exercise test and cardiovascular mortality in middle-aged men
Kai P Savonen1, Timo A Lakka, Jari A Laukkanen
1Kuopio Research Institute of Exercise Medicine, Haapaniementie 16, 70100 Kuopio, Finland.
Insights
A blunted heart rate (HR) increase during exercise, specifically at 40-100% of maximal workload, independently predicts higher cardiovascular disease (CVD) mortality in men. This finding highlights the prognostic value of exercise HR response for CVD risk.
Area of Science:
- Cardiology
- Exercise Physiology
- Preventive Medicine
Background:
- Cardiovascular disease (CVD) remains a leading cause of mortality worldwide.
- Predictive markers for CVD mortality are crucial for risk stratification and intervention.
- Heart rate (HR) response during exercise testing is a readily available physiological measure.
Purpose of the Study:
- To investigate whether the heart rate (HR) response during an exercise stress test independently predicts cardiovascular disease (CVD) mortality.
- To determine the prognostic significance of the exercise HR slope in relation to CVD mortality.
Main Methods:
- A cohort of 1378 men (42-61 years) from eastern Finland without prior coronary heart disease (CHD) or beta-blocker use was studied.
- Heart rate (HR) was measured at rest and during a maximal, symptom-limited exercise test at various workload increments.
- Follow-up averaged 11.4 years, during which cardiovascular disease (CVD) deaths were recorded. Cox-multivariable models were used for analysis.
Main Results:
- A steeper HR increase slope during exercise was observed in survivors compared to those who died from CVD (P<0.001).
- The difference in HR slope steepness was most pronounced between 40-100% of maximal workload (P<0.001).
- A blunted HR increase (maximal HR minus HR at 40% workload) was inversely associated with CVD (P=0.04), CHD (P=0.004), and all-cause mortality (P=0.002) after risk factor adjustment.
Conclusions:
- A blunted heart rate (HR) increase during the 40-100% workload interval of an exercise test is associated with increased cardiovascular disease (CVD) mortality.
- The exercise HR response provides independent prognostic information for CVD mortality.
- This finding underscores the clinical utility of evaluating HR dynamics during exercise testing for risk assessment.
Aims:
The objective is to study whether a heart rate (HR) response during exercise test independently predicts cardiovascular disease (CVD) mortality.
Methods And Results:
The subjects were a representative sample of 1378 men, 42-61 years of age, from eastern Finland with neither prior coronary heart disease (CHD) nor use of beta-blockers at baseline. HR was measured at rest and during a maximal, symptom-limited exercise test at 20, 40, 60, 80, and 100% of maximal workload. During an average follow-up of 11.4 years, there were 56 deaths due to CVD. The slope of HR increase during exercise test was steeper in survivors when compared with those who died due to CVD during follow-up (P<0.001), and the difference in the steepness of HR slope between the groups was the strongest at interval 40-100% (P<0.001). In Cox-multivariable models, maximal HR-HR at 40% workload as a continuous variable was inversely associated with CVD (P=0.04), CHD (P=0.004), and all-cause (P=0.002) mortality after adjustment for known risk factors for CVD death.
Conclusion:
By considering an HR response throughout an exercise test, we found that a blunted HR increase at 40-100% of maximal workload was associated with increased CVD mortality.
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